Dragonfire Account Payment Form Please print clearly or type in all spaces. All prices are in US dollars; see http://www.dragonfire.net/exchange.html for current exchange rates. REMEMBER that checks and money orders not payable through a United States bank (with the exception of Canadian postal money orders) MUST include a US$10 collection fee in addition to any other fees paid. If you are paying for bandwidth over 200MB/day, use the high-bandwith form: http://www.dragonfire.net/pay-high.txt Username: __________________________________________________ Place a mark next to each item desired, enter numbers where necessary, and fill out the totals in the right-hand column: ___ Standard Web/FTP account (200MB/day) ___ $80 per year: ___ year(s) (enter number) --or-- ___ $25 per quarter: 1 / 2 / 3 quarters (circle number) ___ $25 full domain setup (yourname.com/net/...) Domain name: _______________________________ Web/FTP Total................................. US$_____ ___ $15 E-mail setup................................ _____ ___ $5 per additional 5MB of quota: _____ MB........ _____ ___ $10 foreign check / money order fee............. _____ Total............................................ US$_____ Include payment in cash, check, or money order payable to Dragonfire Internet Services for the above amount, and send this form with your payment to: Dragonfire Internet Services (redacted for this retrospective) USA